33 - Subscriber and subscriber id not found.

This rejection from the Insurance payer indicates the patient information in the chart does not match the patient/client information the payer has on record or the claim may have been sent to the wrong insurance payer. This may be a simple typo, inaccurate/missing patient demographic information such as DOB, Gender, Address, or Member ID number.

Error Variations

NM1-09 PATIENT NAME, MEMBER ID NUMBER NOT VALID FOR DOS. [1225541568 -NM1-09 YPYW1253399805]^^^

Category: Acknowledgement/Returned as unprocessable claim The Claim/Encounter has been rejected and has not been entered into the adjudication system Status: Returned to Entity Entity: Payer^^^\\\\R^^R SUBMIT WITH SSN, EDI PI(10) OR MVI ICN (17)^^^

To Resolve

You’ll need to review and/or correct the subscriber information in WebPT EMR (integrated members) or Therabill (Standalone). Follow the steps below to verify the patient subscriber information and ensure all information is accurate for the patient.

Therabill

Follow the steps below to review or change the patient demographics and subscriber information.

1. From the Edit Claim Information section of the EDI rejection page, click the icon next to the client’s name.
    
2. This will bring you to the Client’s Chart. Verify the spelling and information for all fields including demographics, Account & Identifying Numbers, Responsible Party, Referring Physician/Provider, and update as necessary.
   
   
3. If you are not able to find any discrepancies, contact the Insurance payer directly to review the claim and advise how to correct the information.
   1. If you contact the payer's EDI department, you can check for the payer reference number (if provided by the insurance). Click on View Status Messages from the Edit Claim Information section of the EDI rejection page.
      
   2. Then View Details on any Acknowledgement Receipt message. Look for the reference number after [PAYER_REF] =>.
4. If you discover the claim was sent to the wrong insurance payer, this may require you to remap the Insurance Card.

WebPT EMR Integrated Members

WebPT EMR Integrated Members should Review/Edit the Patient Information and Insurance for a more complete fix to the patient subscriber information. This will reduce the potential for this type of recurring error.

1. From the patient's chart select Patient Info.
   
2. Click Edit, to review or change the patient information.
   
3. From the Insurance tab, click Edit next to the insurance details you need to review/change.
   
4. Confirm the correct Insurance Payer radio button is selected, then click Next.
   
5. Review and change any Policy Information, then click Next.
   
6. Review and change any Guarantor Information, click Ok.
7. When finished with your review and updates, click Save Patient on the bottom left.